ABSTRACT
Introduction: On February 202,020, so-called Italian Patient 1 was admitted to the ICU of his local hospital due to a deteriorating clinical condition from SARS-CoV-2/COVID-19 infection. As of June 26th, 239,961 COVID-19 cases have been confirmed in Italy (children = 3805), including deaths (n = 34,708) and who have recovered (n = 187,615). Although children are generally less prone to COVID- 19 and have a milder disease course, children with existing comorbidities could remain at higher risk of complications. Objective: Aim of this study is to document clinical characteristics of children and adolescents with T1D affected with COVID-19. Methods: Starting from the week after lockdown was initiated (March 9th), ISPED started a weekly surveillance for COVID-19 infection on all children with diabetes. Cases with suspected symptoms (n = 1) or children living with positive tested relatives (n = 7), or because hospitalized (n = 3) were undergone to swab test. The surveillance is still ongoing. Results: Eleven patients were diagnosed with COVID-19 (range 6-17 years of age, 7 females);two at T1D onset and nine in patients with established diabetes (diabetes for 1-11 years), all of whom were asymptomatic (n = 7) or had only mild symptoms (n = 4). All had nasopharyngeal swabs positive for SARS-CoV-2 by RT-PCR. Three had mild hyperglycemia, 1 had mild DKA and 2 were admitted for T1D onset, 1 with DKA and 1 without. The remnant children had no disglycemia. Conclusions: In Italy, overall 11 children with T1D had laboratory COVID-19 confirmation. These patients were tested due to having mild COVID-19 symptoms or because they lived close to a known positive patient. These data seem to support the hypothesis that children with T1D are not at higher risk for COVID-19 than general population and have a mild disease course. As the pandemic continues, further work is necessary to assess how this disease affects children and to develop best-evidence-based guidelines for our vulnerable patients.
ABSTRACT
Introduction: The COVID-19 pandemic has had a significant impact the region of Lombardy, causing more than 16,000 deaths. Fortunately, children, including those with type 1 diabetes (T1DM), were only slightly affected. It is debated as to whether COVID-19 infection may increase the incidence of T1DM in children and whether the conditions during and following lockdown may have led to an increased number of diabetic ketoacidosis (DKA) at onset. Objectives: To assess the impact of COVID-19 on T1DM and DKA incidence. Methods: A network of 11 regional pediatric T1DM clinics collected data in children of ages 0-18 years during the time period between March 1-May 31 in the years 2017-2020. Given that all T1DM children are hospitalized at onset and rarely escape this network of regional clinics, it was possible to define a minimal incidence of T1DM without a secondary source, Results: Number of onsets was stable (2017: 206 cases/year, 2018: 199 cases/year, 2019: 233 cases/year, 2020: 105 cases/5 months). DKA at onset varied between 36 and 40% of new onsets. By comparing the cases in the period March 1-May 302,017-2020, an increase in DKA incidence at onset from 11 to 24/1.7 million (p < 003) was found. The minimum regional incidence of T1DM showed a slight increase from 11.7 to 13.7 cases/100000 (0-18 years of age), comparable to previously collected regional data from 2008. Conclusion: These data suggest that COVID-19 infection in Lombardy was not correlated with an in increased T1DM incidence. Furthermore, the minimum regional incidence of TIDM in ages 0-18 years seems stable in the last 10 years. However, a significant increase in the number of DKA at onset was found, many of which were reported to be severe and probably consequent to delayed hospital presentation due to lockdown restrictions and fear of infection, emphasizing the indirect deleterious impact of pandemics on potentially lifethreatening conditions such as DKA.